Hentzen Claire, Musco Stefania, Amarenco Gérard, Del Popolo Giulio, Panicker Jalesh N
Groupe de Recherche Clinique en Neuro-Urologie (GREEN), GRC 01, Sorbonne Université, Hôpital Tenon, AP-HP, Paris, France; Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, London, UK; UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK.
Neuro-Urology Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
Lancet Neurol. 2022 Jun;21(6):551-562. doi: 10.1016/S1474-4422(22)00036-9. Epub 2022 Apr 8.
Sexual difficulties are common in patients with neurological disorders, and different domains of sexual function-desire, arousal, orgasm, and ejaculation-can be affected. Advances in the past 7 years in structural and functional neuroimaging have contributed to a greater understanding of the neural pathways involved in the regulation of sexual functions in health and disease, and this increased knowledge might help with development of future therapeutic strategies. A comprehensive assessment of patients includes history taking-covering the different domains of dysfunction, and primary, secondary, and tertiary contributory factors-as well as clinical examination in select patients (ie, patients for whom an associated non-neurological cause for sexual dysfunction is suspected). Investigations, such as assessment of associated cardiovascular risk factors, might also be indicated in specific situations. PDE5A inhibitors and intracavernosal injections of the prostaglandin alprostadil are effective for treating erectile dysfunction; however, options for managing other domains of sexual dysfunction in men and women remain poor. Research into different domains of sexual dysfunction is likely to lead to additional therapeutic strategies in the future.
性功能障碍在神经疾病患者中很常见，性功能的不同方面——性欲、性唤起、性高潮和射精——都可能受到影响。过去7年中，结构和功能神经影像学的进展有助于更深入地了解健康和疾病状态下参与性功能调节的神经通路，而这些知识的增加可能有助于未来治疗策略的开发。对患者的全面评估包括病史采集——涵盖功能障碍的不同方面以及主要、次要和第三级促成因素——以及对部分患者（即怀疑存在与性功能障碍相关的非神经病因的患者）进行临床检查。在特定情况下，也可能需要进行相关调查，如评估相关心血管危险因素。磷酸二酯酶5A抑制剂和海绵体内注射前列腺素前列地尔对治疗勃起功能障碍有效；然而，治疗男性和女性性功能障碍其他方面的选择仍然有限。对性功能障碍不同方面的研究可能会在未来带来更多治疗策略。
